Driver Subcontractor - PDF by qzb52899

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									                                                                                                        PRIVATE AND CONFIDENTIAL




OWNER DRIVER / SUB-CONTRACTOR APPLICATION FORM
This application has been drawn up to cover the key information we need to establish.
We welcome any additional information or detail you wish to attach to this form eg. References, details of specific skills, knowledge, etc.

PERSONAL DETAILS
Full Name                                                                       Date of Birth
Trading Name                                                                    Age
Address                                                                         Nat Ins Nos
                                                                                Telephone Nos           Home
                                                                                                        Business
                                                                                                        Mobile
Postcode




DETAILS OF VEHICLE(S)
     Vehicle Make & Model             Year           Gross Wgt            Body Type                 Colour                  Length




SUB-CONTRACTOR / EMPLOYMENT HISTORY
                                             Dates                                      Freight
   Company Name & Address            From            To       Area Covered      Parcels / Pallets                Reason for Leaving
INSURANCE
Vehicle Insurance                (Y) / (N)                         Goods In Transit Insurance (GIT)              (Y) / (N)
Current Insurers                                                   Current Insurers
Expiry Date                                                        Expiry Date
                                                                   Liability Limits


           Have you ever been the subject of an insurance investigation                   (Y) / (N)
           Have you ever been convicted of a criminal offence                             (Y) / (N)

           If Yes to either question, please give details on a separate sheet




GEOGRAPHICAL KNOWLEDGE
Please tick the geographical areas you have experience / knowledge of ( )

                                 List areas / postcodes you are very familiar with (if whole county write ALL)

     BELFAST             (   )


    Co ANTRIM            (   )


     Co DOWN             (   )


    Co ARMAGH            (   )


    Co L/DERRY           (   )


    Co TYRONE            (   )


  Co FERMANAGH           (   )




DECLARATION

           I confirm that the above information is correct.
           I understand that any false information or deliberate omission will disqualify me from being considered or
           engaged as an owner driver / sub-contractor, and could lead to my contract being terminated, without notice,
           if either comes to light after commencement of any contract with the company.


           Signed                                                                         Date

								
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